Faculty Bibliography

Little is known about the incidence of bacterial sexually transmitted infections (STIs) among HIV-infected versus HIV-uninfected adolescents. This secondary analysis of a national, multisite study included adolescents aged 12-18 years who were behaviourally HIV-infected (n = 346) or HIV-uninfected but at-risk (n = 182). Incidence rates of bacterial STIs (gonorrhoea, chlamydia [CT] and trichomonas [TV; women]) were calculated using Poisson modelling. Factors associated with incident STIs were explored using Cox proportional hazards modelling. HIV-infected versus HIV-uninfected women had higher TV incidence (1.3 versus 0.6/100 person-months; P = 0.002). HIV-uninfected versus HIV-infected women had higher CT incidence (1.6 versus 1.1/100 person-months; P = 0.04). Among women, demographic, behavioural and HIV-related factors were associated with incident STIs. Among men, there were no differences in incident STIs. In this first analysis comparing STI incidence between HIV-infected and HIV-uninfected adolescents, bacterial STI incidence among women significantly differed by HIV status, and factors associated with incident STIs varied by STI and HIV status.

PURPOSE: To understand linkage to care practices at sites providing clinical services to newly diagnosed HIV-positive adolescents. METHODS: Qualitative analysis of detailed interviews conducted with 28 personnel involved in linkage to care at 15 sites providing specialty care to HIV-positive adolescents. RESULTS: We showed that multiple models exist for linkage to care, and that both formal and informal community relationships are important for successful linkage to care. Stigma was seen as a universal issue, enhancing the importance of the balance of confidentiality and social support. Barriers to care, such as mental health issues, substance use, and transportation, are common. CONCLUSIONS: We conclude that the complexity of linkage to care requires thought and planning as HIV testing is expanded to lower-risk populations.

BACKGROUND:: The objectives of this study were to describe the prevalence and risk factors for HPV infection among HIV-infected young women receiving their first quadrivalent HPV (HPV-6, -11, -16, and -18) vaccine dose. METHODS:: We recruited 16- to 23-year-old women from 14 sites for an HPV vaccine trial. At the first visit, they completed a questionnaire and were tested for cervicovaginal HPV DNA (41 types) and HPV serology (4 vaccine types). Factors associated with any HPV, type-specific HPV, and high-risk (cancer-associated) HPV infections were identified using univariate and multivariable logistic regression. RESULTS:: The mean age of participants (N = 99) was 21.4 years, 30.3% were on antiretroviral therapy, 74.7% were positive for >/=1 HPV DNA type, 53.5% for >/=1 high-risk type, 12.1% for HPV-16, and 5.1% for HPV-18. Most were HPV DNA negative and seronegative for HPV-16 (55.6%) and HPV-18 (73.7%); 45.5% were HPV DNA negative and seronegative for both HPV-16 and -18. Three variables were associated with high-risk HPV DNA in multivariable analysis: non-Hispanic black versus Hispanic ethnicity (adjusted odds ratio [AOR]: 7.06, 95% CI: 1.63 to 30.5), HIV viral load >/= 400 versus <400 copies/mL (AOR: 3.47, 95% CI: 1.28 to 9.43), and frequency of vaginal sex in the past 90 days (AOR: 5.82, 95% CI: 1.30 to 26.11 for >/=6 vs 0 times). CONCLUSIONS:: The prevalence of >/=1 HPV type was high in these young women, demonstrating the importance of vaccinating before sexual initiation. However, most women were HPV DNA negative and seronegative for high-risk vaccine-type HPV infection, supporting vaccination of sexually experienced HIV-positive young women.

Community participation in prevention research has emerged as an important resource for identifying and addressing HIV risk factors and populations that may be more susceptible to these risks. This article focuses on the coalition at the Philadelphia site of Connect to Protect®: Partnerships for Youth Prevention Interventions (C2P), and the partnerships developed to work with an understudied subgroup of young men who have sex with men (YMSM), the House and Ball Community (HBC). The authors describe the coalition's process of identifying HIV risk factors, developing objectives and prevention activities such as increased access to HIV counseling and testing, and building partnerships with the HBC community. Local HIV testing data from C2P affiliated events, additional outcomes, and future directions for the coalition to continue these efforts are presented.

BACKGROUND: HIV-infected youth are at risk of hepatitis B infection and should be vaccinated. Previous reports suggest reduced response to standard hepatitis B vaccine regimens. METHODS: HIV-infected youth, aged 12 to younger than 25 years, were randomly assigned to one of three treatment arms: Arm 1: Engerix B, 20 mug HBsAg; Arm 2: Engerix B (GlaxoSmithKline, Rixensart, Belgium), 40 mug; and Arm 3: Twinrix (GlaxoSmithKline, Rixensart, Belgium), 20 mug HBsAg combined with 720 ELU hepatitis A antigen. Vaccines were administered at Weeks 0, 4, and 24. RESULTS: Characteristics of evaluable patients (n = 336) at entry were similar in the study arms. At enrollment, median CD4+ T-cell count was 460 cells/mm3 (interquartile range, 305-668); 13% were less than 200 cells/mm3. Among Engerix B, 20-mug recipients, 60.4% responded to vaccine (HBsAb 10 IU/mL or greater at Week 28). Improved vaccine response was seen in recipients of Engerix B, 40 mug (73.2% versus Arm 1, P = 0.04) and Twinrix (75.4% versus Arm 1, P = 0.02). In multivariate analysis, only baseline CD4+ T-cell count and study arm were independent predictors of vaccine response. CONCLUSIONS: In HIV-infected youth, a three-dose vaccination regimen with Engerix B, 40 mug, or Twinrix and higher baseline CD4+ T-cell counts were independently associated with improved vaccine response

OBJECTIVES: The present study aimed to describe the experiences of youth with behaviorally acquired HIV who transitioned to adult care, to identify difficulties encountered, and to explore areas for improvement. METHODS: Semi-structured interviews were conducted with 10 young adults ranging from 24 to 29 years old. Themes were derived from coding participant interviews. RESULTS: Participants experienced adolescent care providers as an important source of support, felt anxiety about transition, provided recommendations for improving the process, and described significant changes associated with adult HIV care. CONCLUSIONS: Findings support the development of a clear and structured transition process to address patients' fears and worries through early communication, planning, and coordination for adult healthcare, highlighting the need for future research in this area

Understanding the multiple forms of stigma experienced by young HIV-positive African American men who have sex with men and how they relate to sexual risk behaviors is essential to design effective HIV prevention programs. This study of 40 African American young MSM found that 90% of those surveyed experienced sexual minority stigma, 88% experienced HIV stigma, and 78% experienced dual stigma. Sexual minority stigma was characterized by experiences of social avoidance, and HIV stigma, by shame. Individuals with high HIV stigma were significantly more likely to engage in unprotected sex while high or intoxicated. Associations between stigma and sexual practices were examined; youth endorsing higher levels of sexual minority stigma engaged in less insertive anal intercourse. Individuals endorsing more HIV stigma reported more receptive anal intercourse. These findings support the development of stigma-informed secondary prevention interventions for African American HIV-positive young MSM

Preventing HIV infection in adolescents and young adults will require a multimodal targeted approach, including individual-directed behavioral risk reduction, community-level structural change, and biomedical interventions to prevent sexual transmission. Trials testing biomedical interventions to prevent HIV transmission will require special attention in this population due to the unique psychosocial and physiologic characteristics that differentiate them from older populations. For example, microbicide research will need to consider acceptability, dosing requirements, and coinfection rates that are unique to this population. Preexposure prophylaxis studies also will need to consider potential unique psychosocial issues such as sexual disinhibition and acceptability as well as unique pharmacokinetic parameters of antiretroviral agents. Vaccine trials also face unique issues with this population, including attitudes toward vaccines, risks related to false-positive HIV tests related to vaccine, and different immune responses based on more robust immunity. In this article, we will discuss issues around implementing each of these biomedical prevention modalities in trials among adolescents and young adults to help to guide future successful research targeting this population

Adolescents and youth aged 15-24 are one of the populations most impacted by the global HIV epidemic with an estimated 50% of new infections occurring in this age group. They are thus one of the prime populations for targeting behavioral and biomedical preventions. However, the dynamics of the HIV epidemic in youth vary widely by geographic region and risk behavior profiles. There are also biological and neurodevelopmental considerations that must be considered in the development, testing, and ultimate dissemination of HIV prevention interventions. These concepts are broadly discussed here